Atypical posterior scleritis mimicking choroidal melanoma

Abstract

We report a case of atypical posterior scleritis mimicking amelanotic choroidal melanoma. A 30-year-old healthy Filipino man, with a history of painless subacute loss of vision in his left eye over 5 months, was referred to our institute for further workup and management. On examination, visual acuity of the left eye was 20/200. Anterior segment examination yielded unremarkable results, with injected conjunctiva and quiet episcleral blood vessels, while fundus examination revealed non-pigmented nasal choroidal mass, with significant subretinal fluid resembling amelanotic choroidal melanoma. Right eye examination yielded unremarkable results. The patient was diagnosed with atypical posterior scleritis, and treated with oral steroids for 2 weeks, with no improvement. A periocular steroid was then injected to the left eye, causing dramatic reduction in choroidal mass size, and complete resolution of subretinal fluid. The visual acuity improved to 20/28.5 one month after the injection. Timely treatment was crucial for minimizing vision-threatening complications.

Figure 1

A) Color photograph of the fundus of the left eye, showing a large choroidal non-pigmented lesion nasal to the optic disc. (B) Brightness scan of the left eye, showing a choroidal lesion with dense echogenicity, thickening of the adjacent sclera, and exudative retinal detachment.

Figure 2

Timeline summarizing the patient’s current illness, physical examination results, diagnostic evaluations, and the final diagnosis.

Figure 3

Timeline summarizing the sequence of interventions.

Figure 4

A) Color photograph of the fundus after treatment, showing significant reduction of the choroidal mass with subretinal gliosis and resolution of subretinal fluid. B) Brightness scan, showing significant reduction in retinochoroidal thickening and exudative retinal detachment.